During ostomy surgery, a surgeon creates an opening in the intestine, called a stoma, which is then fixed to the abdominal wall to allow waste to leave the body. This procedure may be necessary for people with inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis), colorectal cancer, or other health issues, in cases where they are unable to evacuate their bowels normally via the anus.
Waste moves from your body through the stoma involuntarily and into a pouch called an ostomy bag, which collects feces. Ostomy bags are odor-free and sealed to prevent leaks, but they need to be changed regularly.
After ostomy surgery, your nurse will explain in detail how to care for your stoma and change your ostomy bag. Here is a quick review of what you need to know to keep your stoma clean and healthy and change your pouch most efficiently.
Your ostomy pouch should ideally be emptied once it’s one-third of the way full, and it should be changed every few days. A good rule of thumb is to never let the pouch fill more than halfway. “This keeps the pouch low profile, which prevents leakage, and keeps the pouch hidden under clothing,” says Jackie McHugh, RN, a certified wound, ostomy, and continence nurse at the Digestive Disease & Surgery Institute at Cleveland Clinic.
Exactly how long you go between changes will depend on the type of ostomy you have, McHugh says.
With an ileostomy, which creates an opening in the small intestine, the pouch will need to be cleaned about every three days. “Due to the acidic nature of the small bowel, the bag will wear at the barrier more quickly,” McHugh says.
For a colostomy, which creates an opening in the large intestine, it may be possible to keep the same bag on for a week, but she advises no longer than that. “There are extended-wear barriers, but no barrier should be worn for more than seven days, to prevent skin breakdown,” she says.
McHugh offers the following step-by-step guide for changing your ostomy bag.
Step 1: Gather Your Supplies
The first step is to gather the supplies you’ll need to change your ostomy bag and clean your stoma. According to McHugh, these include:
A clean towel or paper towels
Nonoily soap
Scissors
Measuring guide
Adhesive remover wipes
Stoma powder
Moisture barrier paste
Pouching system
Step 2: Remove the Old Pouch
The bathroom is a good place to change your ostomy bag. Thoroughly wash your hands before you begin. Then, remove the pouch and empty the contents into the toilet.
“Using the adhesive remover, gently press down on your skin and pull up on the pouch,” McHugh says. “Work from the top to the bottom.” After emptying it, dispose of the pouch in a regular trash bin.
Step 3: Prepare the New Pouch
If you’re using a pouching system that doesn’t come with a precut skin barrier, you’ll need to size and cut an opening. Trace the pattern of your stoma on the back of the skin barrier. Cut the barrier, making sure you cut on the outside edge of the tracing.
“If you are not sure if you cut the opening large enough, or if you think it is too big, you can do a dry fit by laying the skin barrier over the stoma while the backing is on,” McHugh says.
After you have checked the size of the opening, remove the adhesive covering and apply a thin layer of paste around the opening of the skin barrier. “Think about the amount of toothpaste that you use,” McHugh says. “That thin bead of paste is the right amount of coverage needed to fill any gaps.”
Step 4: Wash and Dry the Stoma
The next step is to clean your stoma. Wipe any stool away with toilet paper and dispose of it in the toilet. Then, clean your skin using a moist, soapy towel or paper towels in a circular motion, starting at the base of the stoma and working outward, McHugh says. Once you are sure the skin has been well cleaned, pat it dry with a clean towel.
Step 5: Examine the Skin Around the Stoma
Next, examine the skin surrounding the stoma for any problems. A bit of bleeding is normal. Your skin should be pink or red.
Red, raw, irritated skin can be treated with stoma powder, which can also be used to prevent irritation. “When using the powder, apply a generous amount, but be sure to brush away the excess,” McHugh says. “The powder will stick where it is needed, but leaving too much can prevent the pouch from adhering to your skin.”
If the skin around your stoma is blue, purple, or black, contact your doctor.
Step 6: Apply Your Pouching System
Begin securing the ostomy bag by applying the pouch, with the skin barrier laying directly on your skin. If you’re using a two-piece system, you can attach the pouch to the flange before or after applying the skin barrier.
“After you have placed the skin barrier against your skin, hold the pouching system in place for a few minutes,” McHugh says. “This will help it mold to your body, along with warming the material for a better seal.”
Wash your hands thoroughly when you’re done.
Ostomy surgery creates an opening in the intestine, which is then fixed to the abdominal wall to create a stoma. This allows feces to exit the body, which may be necessary in people with complications from inflammatory bowel disease or colorectal cancer.
Waste from the bowels collects in an ostomy bag that attaches to the opening outside the body.
Ostomy bags are odor-free and easily hidden under clothes. The bags need to be replaced every three to seven days, depending on various factors. A nurse or other healthcare provider will show you how to clean the area around your stoma and replace the ostomy bag.
